of neuroimaging-which, like a live sat-
ellite feed from inside the human body,
permits scientists to track precisely how
a person reacts to a drug (or a placebo) as
soon as he takes it. An injection of saline,
for example, that has been described as a
drug not only will reduce symptoms of
Parkinson's disease but can help a pa-
tient produce more of the dopamine that
the disease destroys. Results like those
have provided scientists with chemical
evidence of something they had long
suspected: simply believing in a treat-
ment can be as effective as the treatment
itself: In several recent studies, placebos
have performed as well as drugs that
Americans spend millions of dollars on
each year.
Transforming interesting laboratory
findings into medicine is never simple,
however, particularly when those find-
ings involve fake pills and sham in-
jections. Some people clearly respond
better to placebos than others, though
we don't know why; some illnesses and
affiictions are more amenable to sugges-
tion than others; and many of the most
intriguing findings are tenuous. Even so,
the recent research is difficult to dismiss.
Through conditioning techniques, for
example, our brain can "learn" different
kinds of placebo effects: people first given
morphine and then a placebo have one
neurochemical response, while people
who take ibuprofen followed by a pla-
cebo have another. Different "doses"
cause different reactions, and studies
have demonstrated that people who
suffer from headaches and consume as-
pirin regularly can associate the shape,
the color, and even the taste of a pill with
a decrease in pain. The value of treat-
ments like those-which have none of
the side effects of drugs-would be im-
mense, but placebos are not pharmaceu-
ticals, and no reputable researcher has
suggested that they will soon be for sale
at your local pharmacy.
Kaptchuk acknowledges that place-
bos are not magic potions. "Placebos
don't shrink tumors," he said. "They
don't make blind people see. If you are
paralyzed, theywon't help you walk." He
deplores the grandiose claims of altern a -
tive medicine and prefers to rely on data.
''Ultimately, I am not a zealot or even a
true believer," he said. "I am sure that I do
not understand the placebo effect. I ask
questions, hopefully valuable questions,
and we will see where the research lands."
Kaptchuk practiced acupuncture for
halfhis adult life. But he stopped twenty
years ago. Despite the popularity of acu-
puncture, clinical studies continually fail
to demonstrate its effectiveness-a fact
that Kaptchuk doesn't dispute. I asked
him how a person who talks about the
primacy of data and disdains what he
calls the "squishiness" of alternative med-
icine could rely so heavily on a therapy
with no proven value. Kaptchuk smiled
broadly. "Because I am a damn good
healer," he said. "That is the difficult
truth. If you needed help and you came
to me, you would get better. Thousands
of people have. Because, in the end, it
isn't really about the needles. It's about
th "
e man.
F or most of human history, placebos
were a fundamental tool in any phy-
sician's armamentarium-sometimes the
only tool. When there was nothing else
to offer, placebos were a salve. The word
itself comes from the Latin for "I will
please." In medieval times, hired mourn-
ers participating in Vespers for the Dead
often chanted the ninth line of Psalm
116: "1 shall please the dead in the land
of the living." Because the mourners were
hired, their emotions were considered in-
sincere. People called them "placebos."
The word has always carried mixed
connotations. Thomas Jefferson wrote
approvingly of what he called a "pious
fraud," and noted that "one of the most
successfill physicians I have ever known
has assured me that he used more bread
pills, drops of coloured water, and pow-
ders of hickory ashes, than of all other
medicines put together." But, as increas-
ingly specific knowledge about human
anatomy emerged, people began to de-
mand scientific answers to medical ques-
tions. Knowledge displaced faith, and
human health improved rapidly. Antibi-
otics are real; placebos are not.
The first publicly acknowledged pla-
cebo-controlled trial-and still among
the most remarkable-took place at the
request of King Louis XVI, in 1784,
under the direction of Benjamin Frank-
lin, then the American Ambassador to
France. The German physician Franz
Anton Mesmer had become famous in
Vienna for a new treatment he called
"animal magnetism," and he claimed to
have discovered a healing fluid that
"-
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